Therapy, Meditation, Sleep and Exercise Can Help Lessen Anxiety

Different techniques that have been proven to control anxiety

When Lisa Jones was in college, her once-manageable anxiety became overwhelming.“I was having three or four panic attacks a day,” she says. “My hands were shaking. I felt I needed to run and hide. I would hyperventilate sometimes to the point of blacking out. I knew I needed help.”

Lisa’s doctor referred her to Frances P. Thorndike, PhD, an Assistant Professor in the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia Health System, in Charlottesville, who also has a private practice. Lisa’s doctor had prescribed medication, and Thorndike recommended that she also start a program of Cognitive Behavioral Therapy (CBT), a technique that gives patients tools to control their own anxiety. Lisa also began meditating, starting with 10 minutes a day, on her own.

Lisa very quickly started to see results. “Even though the treatment didn’t immediately cut down the number of panic attacks, I felt better,” she says. “I felt like I had control, and I didn’t have to let the panic attack take over my life.”

Lisa, who wasn’t opposed to medication, decided to hold off and try the therapy alone first. Still, knowing the medication was available gave her comfort. “It was helpful to know that it was OK to take it if I needed it,” she says. There is ample evidence that techniques including CBT, meditation, sleep strategies and exercise can help people with anxiety disorder. People who try these techniques may still need medication, however, to manage extreme symptoms, help get them through the first stages of therapy, or, like Lisa, to keep on the shelf for a “break-glass-in-case-of-emergency moment.”

CBT: Tools for Living

Many studies show that Cognitive Behavioral Therapy (CBT) can teach people with anxiety disorder to manage their condition. Recently, a November 2013 study, published in Behavior Research and Therapy, tracked 361 people with panic disorder as they completed an 11-session course of CBT. The study showed “strong evidence” that CBT reduced panic symptoms. “Medications for anxiety disorder can certainly be helpful,” explains Thorndike. “But CBT actually changes thought patterns and behaviors that cause anxiety and keep it going.”

If you choose this type of therapy you will learn techniques to cope with your situation and feelings, and those techniques will be tailored to your unique situation, Thorndike says. You will learn techniques to deal with anxiety, including relaxation and deep breathing, as well as cognitive tools – things you can say to yourself to challenge and control your fears. Eventually, you will practice using these techniques when exposed to your trigger, the situation that produces anxiety. “We start gradually,” Thorndike says. For example, if someone is afraid of dogs, “we may start by looking at pictures of dogs, and then going to a park and watching them from a distance,” she says.

To find a therapist who practices CBT ask your doctor or the Therapist Directory of the ADAA. While one-to-one therapy is ideal, you can also try to learn some of these techniques on your own. Thorndike recommends starting with The Anxiety and Phobia Workbook by Edmund J. Bourne (New Harbinger Publications, 2011). In addition, a review in the January 2014 issue of Current Opinion in Psychiatry found that “recent studies have confirmed the utility of computerized psychotherapy for anxiety” although more research is needed. If you want to try an online program, Thorndike recommends you use Beacon 2.0, to search for the right program.

Mindfulness Meditation: Living in the Moment

Another technique that has been proven to control anxiety is mindfulness meditation. This is a type of meditation that teaches you to be aware of the present moment—your thoughts, emotions, and sensations—with an attitude of acceptance.

Elizabeth Hoge, MD, an Assistant Professor of Psychiatry at Harvard Medical School in Boston, is a psychiatrist with a specialty in anxiety disorders. Her study on mindfulness meditation was published in the August 2013 issue of the Journal of Clinical Psychiatry (view a summary here). For this study, 93 people were asked about their symptoms and put through a stress test both before and after training. Half had training in mindfulness meditation, and half attended an education class. Those who learned to meditate had less stress on the second test than those who didn’t, says Dr. Hoge, who is also affiliated with the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital.

Why does meditation help? “Mindfulness meditation starts with a practice of focusing on your breath,” says Dr. Hoge. “As your thoughts arise, you are taught to just notice them there, like a cloud passing in the sky, and not react to them.” With practice, people with anxiety disorder can use these techniques to control their reactions to negative thoughts in daily life.

While any form of meditation will help, she says, her research study used mindfulness meditation, which is derived from Vipassana or Insight, meditation. You can find information on Insight meditation at the website of the Insight Meditation Society, www.dharma.org. There are also many books on meditation technique, including Wherever You Go, There You Are by Jon Kabat-Zinn (Hyperion, 2005).

Get Your Rest

Sleep and anxiety are intertwined, says Thorndike. “People who are anxious may struggle with falling asleep or wake up during the night,” she says. Being overtired can make people more prone to anxiety and less able to cope with its symptoms as well, she adds.

Try some simple steps to improve your sleep at night. “Your bed should be saved only for sleep or sex,” she says. “If you are awake for more than 15 or 20 minutes, leave the room. Don’t lie in bed and worry.”

It is also important to keep screens, phones, and TV out of the bedroom, maintain consistent bed and wake times, avoid caffeine in the afternoon and avoid exercising late in the evening. If you want help doing this, consider trying an online program. A 2013 study in the Journal of Clinical Psychology, co-authored by Thorndike, found that adults using an online sleep program saw improvements in both sleep and anxiety. Thorndike has helped develop one called SHUTi.

Get Moving

Exercise can help as well, Thorndike says. Researchers at Princeton University recently found that mice who exercised were calmer than those who were more sedentary — and had developed more new brain cells as well. Even if you are out of shape, “start wherever you can, depending on your fitness level,” Thorndike says. “It is only important to do it regularly and consistently.” Eventually, try to build to a program of exercise of at least 30 minutes 3 times weekly.

For Lisa, a little more than a year of therapy gave her the tools she needs to manage her anxiety daily. Today, she meditates daily, practices yoga, and uses the skills she learned from Thorndike. “I still get the symptoms of panic attacks,” she says. “I still have all the same triggers. But when I feel the attack coming on, I can use these tools to squash it.“

Ellen Wlody is a writer who specializes in health and parenting topics. She lives in upstate New York with her husband, children, and two dogs.


Ellen Wlody

Ellen Wlody

Ellen Wlody is a writer who specializes in health and parenting topics. She lives in upstate New York with her husband, children, and two dogs.


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